Astigmatic axis independent spatial frequency and contrast sensitivity target and method

ABSTRACT

A set of visual targets and a method for using these targets to evaluate the spatial frequency response and contrast sensitivity of the human visual system. The invention includes four choice test, six choice test, sinusoidal bulls eye and fundamental sinusoidal letters or optotype targets. The four and six choice targets feature sinusoidal gratings oriented vertically, horizontally and at angles thereto. The sinusoidal bull&#39;s eye target features concentric circular light and dark areas with brightness varying in a radial sinusoidal fashion. The fundamental sinusoidal optotype target features an optotype, such as a letter, that is made up of strokes, each of which have a width that is equal to ½ of a single sinusoidal period.

CLAIM OF PRIORITY

This application is a continuation application of U.S. Ser. No.10/694,609, filed Oct. 27, 2003, which claims priority from U.S.Provisional Patent Application Ser. No. 60/422,084, filed Oct. 29, 2002,the disclosures of which are hereby incorporated by reference.

BACKGROUND OF THE INVENTION

Prior art charts and targets, such as those illustrated in U.S. Pat.Nos. 5,500,699 and 5,414,479 to Ginsburg, yield variable resultsdepending on the axis of residual astigmatism and higher orderaberrations such as vertical coma and other non-rotationally symmetricaberrations. More specifically, prior targets used for measuringcontrast sensitivity and spatial frequency response in their preferredembodiment have rows and columns of patches that are presented against awhite background. The targets are comprised of patches (˜1.4° of solidviewing angle) of gratings having successive parallel aligned light anddark areas, which parallel aligned light and dark areas havesubstantially linear character with the contrast levels and/or spatialfrequency or size. These gratings are oriented vertically and at ±15° ofvertical (left of vertical, vertical and right of vertical) resulting in“three choice test” (three forced choices). The spatial frequenciescovered by the targets may range from 0.5 to 64 cycles per degree (CPD),but typically the values have been L5, 3, 6, 12 and 18 CPD. The patientis asked to identify the direction of the lines (left of vertical,vertical and right of vertical). The lowest contrast level that eachspatial frequency is correctly identified is considered the contrastthreshold from which the contrast sensitivity is determined.

Contrast sensitivity testing and spatial frequency response may beperformed with a patient's best refraction (spectacles, contacts lenses,etc.) or with no correction in place. The need for taking thesemeasurements with or without refractions has become extremely importantin determining the visual outcomes from refractive surgery {radialkeratotomy, Photorefractive Keratectomy (PRK) and Laser AssistedKeratomillieusis in Situ (LASIK) and phakic intraocular lenses}.

The problem with the current embodiment of the targets is that they arespatially biased in one direction (usually vertical or near vertical).Refractive errors such as astigmatism and higher order aberrations(coma, trefoil, tetrafoil, ) cause lines to appear darker (highercontrast) in one angular orientation than in the orthogonal orientationwhere they appear much lighter (lower contrast). In fact, the findingthat lines appear darker in one meridian than another is used todetermine the axis (orientation) of the astigmatism and higher orderaberrations. The Lancaster Wheel and Sunburst target (FIG. 1A & B) areexamples of these tests. In FIG. 1A, the actual appearance of the targetis with all radial lines appearing equally dark. With astigmatism andnon-rotationally symmetric higher order vertical aberrations the linesappear darker (higher contrast) in the meridian nearest the retina andlighter (lower contrast) in the orthogonal meridian, as shown in FIG.1B.

Astigmatism simply means the power of the eye is similar to a torus,biconic or toric ellipsoid where there is a strong and a weak power thatare 90° apart. In FIG. 1B, the darkest line in the Clock pattern isalong the meridian that is 2 o'clock (30° from horizontal). The lightestline is 90° away at 11 o'clock. A patient with astigmatism oriented at30° would see the sunburst with this appearance. Astigmatism can occurat any axis, so the appearance of the Sunburst or Clock pattern willappear differently depending on the amount and orientation of theastigmatism. Astigmatism is one of the simplest of optical errors and istherefore considered to be Lower Order Aberration optically and can becorrected with spectacles. Higher order aberrations of the eye can occuralso (coma, trefoil, tetrafoil, . . . ) which are more complexaberrations of the optical system that cannot be corrected withspectacles. They do however, cause the Sunburst pattern to haveirregularly darker and lighter spokes. Depending on the exactaberrations of the individual, vertical or near vertical lines willappear differently to each individual causing a difference in thethreshold of the contrast of the actual lines seen.

The astigmatic patient with a vertical focal line nearer the retina willsee the vertical gratings at a much higher contrast than a person with ahorizontal focal line nearer the retina. The result is that theorientations of the astigmatism and non-rotationally higher orderaberrations have a direct impact on the results of the contrastsensitivity test and the spatial frequency response. This should notoccur. The axis of astigmatism and orientation of symmetric higher orderaberrations should have no impact on the contrast sensitivity or spatialfrequency response. The method to follow using linear gratings at otherorientations, the new “rotationally” symmetric target (“SinusoidalBull's Eye” target) and the “fundamental sinusoidal” letters eliminateor reduce any effect of non-rotational refractive errors (low and higherorder aberrations).

Aberrations such as astigmatism and other higher order aberrations canmake the contrast of the lines vary by large contrast amounts (greaterthan 50% difference in contrast). Because the appearance of the targetcontrast to the patient is reduced by the aberrations, the results ofthe contrast threshold are variable and depend of the orientation of theaberration.

SUMMARY OF INVENTION

The invention is a set of visual targets and method of using thesetargets to evaluate the spatial frequency response and contrastsensitivity of the human visual system. The invention is an improvementover prior art charts and targets, such as those presented in U.S. Pat.Nos. 5,500,699 and 5,414,479 to Ginsburg. The previous charts andtargets yield variable results depending on the axis of astigmatism androtational orientation and higher order aberrations such as verticalcoma and other non-rotationally symmetric aberrations (FIG. 1B).

The invention includes, but is not limited to, Four Choice Test, SixChoice Test, Rotationally Symmetric (Sinusoidal Bull's Eye) Target Testand Fundamental Sinusoidal Letters or Optotype embodiments. The FourChoice Test has sinusoidal gratings oriented at four differentmeridians, each separated by 45°. Having these four orientations andpresenting them randomly will “average out” any bias due to theorientation of the astigmatism, because there is no overall bias in theorientation of the targets (not all vertical or near vertical).

The Six Choice Test has sinusoidal gratings oriented at six differentmeridians, each separated by 30°. Having these six orientations andpresenting them randomly will “average out” any bias due to theorientation of the astigmatism, because there is no overall bias in theorientation of the targets (not all vertical or near vertical). The SixChoice “Test is superior to the Four Choice Test in that the patient hasonly a 1 in 6 chance of guessing (false positive) as opposed to 1 in 4.The disadvantage is the test requires more presentation and thereforerequires more time.

The Sinusoidal Bull's Eye has a spatial frequency that is the same aslinear gratings, but the target is rotationally symmetric. Patients withastigmatism and other non-rotationally symmetric aberrations will haveno advantage or disadvantage in the appearance of the target. For twopatients with the same amount (magnitude) of astigmatism, but atdifferent orientations, the target will appear the same, only rotated.The result is no difference in the apparent contrast of the target.

The Fundamental Sinusoidal Letters are comprised of sinusoidal elementsor “strokes'⁹ that can make the 26 letters of the Arabic alphabet.Although Sloan has shown that 10 of these letters (D, K, R, H, V, C, N,Z, S, O) have the same difficulty for recognition the technique may beused for any letters or symbols that can be made with multiple segments(strokes or elements) in any language [Ref 1: Sloan, L, Rowland W M andAltaian A. Comparison of three types of test target for the measurementof visual acuity. Q. Rev. Ophthal. 8:4-16 (1952). Ref. 2: RecommendedStandard Procedures for the Clinical Measurement and Specification ofVisual Acuity. Report of Working Group 39. Adv. Ophthal. Vol. 41, pp.103-148 (Karger, Basel 1980).] Although some letters may have a slightdirectional bias for astigmatism, the use of multiple letters averagesout any bias, similar to standard visual acuity testing. The FundamentalSinusoidal Optotype iŝnot limited to letters, but may be used-for anyother optotype or symbol used in visual acuity or contrast sensitivitytesting.

For a more complete understanding of the nature and scope of theinvention, reference may now be had to the following detaileddescription of embodiments thereof taken in conjunction with theappended claims and accompanying drawings.]

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1A illustrates Sunburst, Clock (or Wheel) and Lancaster Cross priorart targets.

FIG. 1B illustrates the appearance of the prior art Wheel target to apatient having astigmatism at 30°.

FIG. 2 illustrates the targets of a Four Choice Test embodiment of thepresent invention.

FIG. 3 illustrates the targets of a Six Choice Test embodiment of thepresent invention.

FIG. 4 illustrates a Sinusoidal Bull's Eye Target embodiment of thepresent invention.

FIG. 5 illustrates a Fundamental Sinusoidal Letter Target embodiment ofthe present invention.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

As a prelude to a description of the invention and its embodiments, itis helpful to present the following definitions so that the concepts setforth therein may be more readily understood. It should be noted thatthe terms “chart” and “target” are used interchangeably throughout thefollowing description.

Meridians and Semi-meridians: A meridian is any diameter through thecenter of a circle. A semi-meridian is any radius. Clock hours aresemi-meridians and meridians would be pairs of semi-meridians (9-3,10-4, 11-5, . . . . The semi-meridians may also be described in degreeswhere each clock hour is 30°. The 3 o'clock semi-meridian is consideredzero degrees and the angle increases positively in a counter-clockwisemanner as in a standard polar coordinate system.

Contrast Levels: The contrast between two adjacent brightnesses isdefined as the difference in the brightnesses divided by the sum of thebrightnesses. For example, a projected target may have a 98 luxbrightness at the peak level and 2 lux brightness in the dark area, thecontrast is (98−2)/(98+2)=96% contrast. Because the visual systemresponds exponentially to contrast, contrast levels are often given incommon log units. Therefore, zero log units is 100% contrast, −1 logunits is 10% contrast, −2 log units is 1% contrast and −3 log units is0.1% contrast. The normal human contrast threshold is within this range.Sometimes Octave steps (doubling) are used, which is equivalent to−0.301 log units change in contrast. Decibels (dB) may also be used. Adecibel is ten times the log unit. Therefore, −0.301 log units isequivalent to −3.01 dB.

Spatial frequency: Spatial frequency is the number of times that a cycleis repeated over a given distance. Distances are measured using thevisual angle, so the unit of measure is usually in cycles (number ofsinusoids) that occur in a single degree. For example, 30 cycles perdegree, means that the sinusoidal pattern is repeated 30 times in anangle of 1 degree. For the Fundamental Sinusoidal letters, each strokeis considered to be ½ the fundamental sinusoidal period. For 30 cyclesper degree, the width of each stroke of a letter would be 1/60 of adegree and the height and length of each letter would be equal and 5times larger than the width of a stroke, as is the standard for lettersused in visual acuity testing (previous 2 references).

With reference to FIG. 1A, the Sunburst, Wheel and Lancaster cross areall examples of radial lines emanating from a point. When a patient hasastigmatism or higher order non-rotationally symmetric aberration, thelines will no longer appear equally dark.

The appearance of the Wheel to a person with astigmatism at 30° ispresented in FIG. 1B. If a patient's astigmatism were at 60°, the 1o'clock line would appear darker. Although astigmatism is more commonlyvertical when people are young and horizontal when people are old,astigmatism can occur at any orientation in the human population. Thepresent invention overcomes the disadvantages of prior art charts andtargets described with reference to FIGS. 1A and 1B.

Turning to FIG. 2, the first embodiment of the present invention is aFour Choice Test (4 forced choices). Rather than all targets beingoriented vertically or near vertical (±15°) the four targets areoriented 45° apart (horizontally, 45°, vertically and 135°).

While the targets of the Four Choice Test embodiment of the presentinvention, at multiple spatial frequencies and contrast levels, may becombined on a single wall chart, in the fashion illustrated in U.S. Pat.No. 5,500,699 to Ginsburg, for example, the preferred form of creationand display of the targets is one at a time by software on the screen ofa computer monitor, More specifically, a patient sits and faces themonitor. As an example, for a monitor having an approximately 15″ to 60″diagonal screen, with each target displayed on the monitor ranging from1 minute of visual arc to 2° of visual arc and visual angle, the patientmay sit approximately 5? to 30* from the screen and the ambient lightingin the room would be dark (less than 5 foot-candles).

A spatial frequency, typically the highest, is chosen by the physician(or technician) and then a target showing the highest contrast level atthat frequency is displayed to the patient on the monitor. The patientthen identifies the grating direction of the displayed target. This maybe accomplished in a variety of ways. For example, the patient mayrespond verbally or click one of four buttons, with each button labeledwith one of the grating directions. Successive targets for the frequencyare displayed to the patient, with the directions of the gratings variedrandomly, at progressively lower contrast levels. When the patient isunable to detect a target grating orientation or direction at aparticular contrast level, additional targets at the same contrast levelhaving different grating orientations are displayed. This approach isrepeated as the contrast levels continue to lower. The physician recordsthe last threshold contrast level before the patient is no longer ableto identify the orientations of any of the target gratings at aparticular contrast level. A second spatial frequency is selected andthe above process is repeated. As an example only, five spatialfrequencies may be selected for a test session having, for example,cycles of 1.5, 3₅ 6, 12 and 24 CPD.

The Four Choice Test increases the specificity by 25% (four choicesrather than three) by reducing the number of false positives (randomchance of simply guessing correctly). Since the targets are equallyspaced rotationally, any directional aberration (astigmatism, verticalcoma and trefoil) will be averaged out by the testing. Multiple targetsat the four orientations at the same spatial frequency and contrastwould be required for the average to be precise.

A second embodiment of the present invention is a Six Choice Test (6forced choices), as shown in FIG. 3. The Six Choice Test is performed inthe same manner as described above for the Four Choice Test but doublesthe number of choices from the three choice test. The targets areoriented at 9-3, 10-4, 11-5, 12-6, 1-7 and 2-8 clock hours with are in30° increments. The additional choices further increase the specificityof the test and reduce the number of false positives. The patient isasked to identify the orientation of the target by the clock hour oforientation. As with the Four Choice Test, this may be accomplished in avariety of ways. For example, the patient may respond verbally or clickone of six buttons, with each button labeled with one of the gratingdirections.

A third embodiment of the present invention is a new Sinusoidal Bull'sEye (Rotationally Symmetric) Target, illustrated in FIG. 4, thateliminates the need for multiple presentations because there is noeffect from the orientation of astigmatism or other non-rotationalhigher order aberrations. The Sinusoidal Bull's Eye Target of FIG. 4 isformed by a cross-section sinusoid that is pivoted around either thepeak or valley of the sinusoid. In other words, the new target is asinusoid rotated around a peak (center bright) or valley (center dark).Either polarity should be available. The center spot has ½ period andeach (bright or dark) ring is ½ period. The fundamental spatialfrequency can be for any spatial frequency. Normal human testing isusually between 0.5 and 60 cycles per degree. The rotationally symmetricnature of the sinusoidal bulls' eye target results in the light and darkareas being substantially uniform over a circumference thereof asevidenced in FIG. 4.

A fourth embodiment of the present invention is new FundamentalSinusoidal Letters Target, illustrated in FIG. 5. The FundamentalSinusoidal Letter “E” of FIG. 5 is formed by four “strokes” or elements,indicated at 10 a, 10 b, 10 c, and 10 d. It is to be understood thatwhile only straight or linear strokes are illustrated in FIG. 5, thestrokes may also be curved. Each single “stroke” or element of theletter has a central peak (center bright) or valley (center dark),illustrated at 6 for the sinusoid indicated in general at 7 and 8 forsinusoid indicated in general at 9 in FIG. 5, that tapers off in alldirections sinusoidal for ½ period. Each letter is then constructedusing “strokes” so that the edges of each stroke intersect at the ½period. The fundamental spatial frequency is determined by the width ofthe stroke indicated at 12 and 14 in FIG. 5. The height (18 in FIG. 5)and width (12 plus 16 in FIG. 5) of the letter are equal and 5 timeslarger than the width of a stroke (12, 14). A Fundamental Letterequivalent to 30 cycles/degree would have a stroke width of 1/60 ofdegree (1 minute of arc) width.

As an alternative to the embodiment illustrated in FIG. 5, theFundamental Sinusoidal Optotype is not limited to letters, but may beused for any other optotype or symbol used in visual acuity or contrastsensitivity testing. The basic principle is to use the FundamentalSinusoidal Segment (stroke or element) to construct the optotype. Usingthese Fundamental Sinusoidal Segments to construct an optotype or symboleliminates higher spatial frequencies at the corners and curves, whichhas been a criticism of using letters (or other complex optotypes) forcontrast sensitivity or standard visual acuity testing. Any optotype,symbol or letter constructed in this matter eliminating the higherspatial frequencies and providing “pure” spatial frequency result at anyspatial frequency.

As with the Four and Six Choice Tests, the targets of FIG. 4 and 5 arepreferably presented to the patient on a computer screen, but may alsobe displayed on a chart or slide, after an initial spatial frequency isselected by the physician. Furthermore, as with the Four and Six ChoiceTests, successive targets are presented to the patient, each targethaving a progressively lower contrast level. A control disk, however, israndomly displayed to the patient in place of the target of FIG. 4. Thecontrol disk is a gray disk of the same diameter as the SinusoidalBull's Eye Target. The gray disk would be the same as the MEANbrightness of the Sinusoidal Bull's Eye Target. The test would be a“forced two choice”. “Do you see a Bull's Eye or a Gray Disk?” Thepatient may answer in a variety of ways such as by a verbal response orclicking one of two buttons where one button is labeled “Yes, Bull's Eyeis present” and the other button is labeled “No, Bull's Eye is NOTpresent, it is a gray disk.” In the case of FIG. 5, the patient would beasked to identify or “name” the optotype that is being displayed. Thepatient may answer in a variety of ways such as by a verbal response orby clicking a button corresponding to the letter or other optotype or,if the optotype is not seen, by clicking a button that is labeled “Nooptotype is present.” When the patient is no longer able to detect theBull's Eve, or identify the optotype, the physician writes down the lastthreshold contrast level that was repeatable. This test is the best for“automated” display on the computer monitor because there are only twochoices so it goes very fast. With big steps, little steps and doublechecks of the threshold level reported.

It should be noted that, in addition to the preferred method ofdisplaying the targets on a computer screen, the various targets of theembodiments of the invention described above may be created anddisplayed in any way known in the prior art including, but not limitedto, projection onto a screen, printing on paper or the like and/ordisplaying on a high definition television system.

While the preferred embodiments of the invention have been shown anddescribed, it will be apparent to those skilled in the art that changesand modifications may be made therein without departing from the spiritof the invention, the scope of which is defined by the appended claims.

1. (canceled)
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 4. A substantially sinusoidalbull's eye target for testing spatial frequency and contrast sensitivitycomprising concentric circular light and dark areas with brightnessvarying in a substantially sinusoidal fashion and having a spatialfrequency and a contrast level.
 5. A set of targets for testing spatialfrequency and contrast sensitivity comprising: a) a plurality ofsubstantially sinusoidal bull's eye targets, each featuring concentriccircular light and dark areas with brightness varying in a substantiallysinusoidal fashion; and b) each of said plurality of substantiallysinusoidal bull's eye targets having a unique combination of spatialfrequency and contrast level.
 6. A fundamental substantially sinusoidaloptotype target for testing spatial frequency and contrast sensitivitycomprising an optotype constructed from a plurality of strokes, whereeach of said strokes features a width equal to is substantially a singlesinusoidal period and a length that is substantially a multiple of thewidth.
 7. The fundamental substantially sinusoidal optotype target ofclaim 6 wherein the optotype is a letter.
 8. The fundamentalsubstantially sinusoidal optotype target of claim 6 wherein the optotypefeatures a width and a length that are equal to each other and fivetimes the stroke width.
 9. (canceled)
 10. (canceled)
 11. (canceled) 12.(canceled)
 13. (canceled)
 14. (canceled)
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 16. (canceled)17. A method of testing spatial frequency and contrast sensitivitycomprising the steps of: a) providing a plurality of substantiallysinusoidal bull's eye targets having concentric circular light and darkareas with brightness varying in a substantially sinusoidal fashion, thelight and dark areas being substantially uniform over a circumferencethereof, and each of said targets having a unique combination of spatialfrequency and contrast level; b) providing a control; c) displaying oneof said substantially sinusoidal bull's eye targets to a patient; d)asking the patient if he sees the substantially sinusoidal bull's eyetarget; e) displaying the control; and f) asking the patient if he seesthe substantially sinusoidal bull's eye target.
 18. (canceled) 19.(canceled)
 20. (canceled)